Divergent trajectories in pancreatic cancer burden among older adults (55+): a GBD 2021 analysis revealing China's dual epidemic of aging and population growth (1990-2045)

Abstract

Background: The global population aging trend has intensified concerns regarding pancreatic cancer (PC), a leading cause of cancer-related mortality with a 5-year survival rate of 13%. This study evaluates the global burden, temporal trends, and socioeconomic disparities of PC among individuals aged ≥55 years using the 2021 Global Burden of Disease (GBD) data.

Methods: Age-standardized incidence, prevalence, mortality, and disability-adjusted life years (DALYs) were analyzed across 204 countries. Joinpoint regression identified temporal trends (1990-2021), while Bayesian Age-Period-Cohort (BAPC) modeling projected future burden. Socioeconomic disparities were assessed via the Socio-demographic Index (SDI), and risk factor contributions were quantified using decomposition analysis.

Results: In 2021, Finland, Germany, and Japan exhibited the highest age-standardized PC prevalence (ASPR: 64.42-66.17 per 100,000 population), contrasting sharply with Mozambique (ASPR: 2.85 per 100,000 population). Mortality peaked in Greenland (age-standardized death rate, ASDR: 81.85 per 100,000 population) and Monaco (ASDR: 71.75 per 100,000 population). Males showed elevated burden across incidence, prevalence, and mortality (peak age: 70-74 years), with global trends persistently rising (average annual percentage change, AAPC >0, 1990-2021). China experienced a transient mortality decline (AAPC = -0.93, 2011-2015), linked to healthcare reforms. High SDI regions (e.g., Japan) faced amplified burdens driven by aging and metabolic risks, while smoking (15.4-28.5% of deaths and years lived with disability, YLDs) and hyperglycemia (37.8% of YLDs in the U.S.) dominated modifiable risks. Projections diverge significantly: China's age-standardized incidence rate (ASIR) burden is projected to increase from 27.96 (95% uncertainty interval, UI: 25.76, 30.16) in 2022 to 36.94 (UI: 0, 79.46) by 2045. In contrast, the global ASIR is expected to decline from 31.07 (UI: 30.06, 32.08) to 27.11 (UI: 8.73, 45.57).

Conclusion: Persistent socioeconomic and gender disparities underscore the need for targeted interventions, including tobacco control, glycemic management, and lifestyle modifications. Prioritizing aging populations in high-SDI regions and addressing underreported risks in low-SDI areas are critical for mitigating the growing PC burden.

Keywords: 55+ years old cohort; GBD 2021; global burden of disease; pancreatic cancer; risk factors; socioeconomic disparities.

Figure 1

Aged 55+ cohort global distribution maps of the disease burden of pancreatic cancer 204 countries and regions in 2021. (A) Age–standardized Prevalence rate (ASPR) in 2021; (B) Age–standardized Deaths rate (ASDR) in 2021.

Figure 2

Shows pancreatic cancer prevalence, incidence, and mortality among the people Aged 55+ globally, by age and gender. In (A,C,E), bar charts show counts for each age group (red for females, green for males, values labeled above). In (B,D,F), curves show rate trends (red for females, green for males).

Figure 3

The APC and AAPC of ASR for incidence (A,B), DALYs (C,D), and deaths (E,F) in PC at the global and China level based on the joinpoint regression analysis model.

Figure 4

(A) Slope index of the ASR - deaths; (B) Concentration index of ASR - deaths. (C) Slope index of ASR - DALYs; (D) Concentration index of the ASR - DALYs.

Figure 5

(A) Decomposition analysis. (B) BAPC model for Incidence. (C) BAPC model for Deaths.

Figure 6

(A) Attribution analysis of Deaths. (B) Attribution analysis of YLDs.